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LONDON, UK: Seeking to improve oral cancer detection and treatment, researchers from Queen Mary University of London have developed the first polymerase chain reaction (PCR) test for oral cancer detection. Besides yielding rapid results, the test, called the quantitative Malignant Index Diagnosis System (qMIDS), is cost-efficient and easy to use and could relieve pressure on the healthcare services in the country.
According to the National Health Service, mouth cancer is the sixth most common cancer in the world. In the UK, around 8,300 cases of mouth cancer are detected every year. Although seven in ten of these cancer cases start with pre-malignant lesions, only one in ten such lesions will develop into cancer.
Until now, researchers have not been able to find an optimal way to identify the lesions that could become cancerous. One method has been to use a grading system to examine tissue samples under a microscope. However, the malignancy grading system often lacks accuracy and precision.
If a clinician is unclear of whether a lesion in the mouth is cancerous, patients with pre-malignancy must be reviewed regularly over an extended period, no matter their risk level. This can be upsetting and disruptive for the patient and costly for the healthcare system. However, a mild case may quickly develop into cancer, and if the patient is unaware of this, he or she may seek treatment late. Delayed care is often more aggressive and expensive and may drastically reduce survival rates.
Senior researcher Dr Iain Hutchison, professor of oral and maxillofacial surgery at Queen Mary, said in a university press release: “qMIDS will help us identify patients with pre-malignancies that will never transform into cancer, so they can be reassured and discharged from hospital review. Patients with high-risk pre-malignancy can have minor surgery to remove the lesion before it has transformed into cancer, thereby curing the patient and saving them major surgery, which in turn reduces health service costs. It is a powerful tool especially when used in conjunction with conventional histopathology assessment.”
Commenting on the importance of early cancer detection, qMIDS inventor Dr Muy-Teck Teh told Dental Tribune International (DTI): “I have always believed that early cancer detection is key to a successful treatment outcome. Catching cancer early means that treatment would be easier and less harmful. Most importantly, early treatment has a significantly higher chance of cure for the patient.”
Despite its advantages, the test is not yet available for use. “As a molecular biologist, I have been researching cancer genes using qPCR [quantitative PCR] for over 20 years. As detecting these genes using qPCR is so reliable and fast, it upsets me that such superb technology is not widely used for cancer diagnosis. It is unacceptable that patients have to wait between one and three weeks for their pathology reports when there is already a fantastic, cost-effective qPCR technology that can provide results within hours,” Dr Teh commented.
Dr Teh also noted that, since oral cancers are more prevalent in lower socio-economic groups, improving accessibility to qMIDS could optimise case finding in deprived and high-risk populations.
The qMIDS diagnostic test can be carried out on multiple lesion sites throughout the mouth where large areas are affected. The results can be achieved 90 minutes after reaching the technician, and the test can detect both low-risk and high-risk oral cancer patients, thus improving cure rates and treatment outcomes. According to the researchers, since the test is based on chemical detection and automated digital quantification, the risk of human error is minimised.
Dr Teh told DTI that the qMIDS test now qualifies for a clinical prospective study to confirm its diagnostic capability in a real-world clinical setting. However, further funding is needed to implement and integrate the test into existing healthcare infrastructure before it becomes available for public use.
Similarities to PCR test for SARS-CoV-2 detection
Dr Teh explained that, like COVID-19 PCR tests, the qMIDS test detects RNA. Additionally, both tests require a laboratory technician to run the qPCR machine and perform the analysis. However, there are two key differences.
Firstly, the COVID-19 PCR test requires a nasal or oral swab, whereas the qMIDS test needs a tiny 1 mm tissue biopsy, which can be taken by a general dentist or an oral surgeon. Secondly, COVID-19 PCR tests detect less than a handful of viral genes, whereas the qMIDS test can detect 16 human genes.
The study, titled “Molecular signatures of tumour and its microenvironment for precise quantitative diagnosis of oral squamous cell carcinoma: An international multi-cohort diagnostic validation study”, was published online on 9 March 2022 in Cancers.